Staphylococcus is a genus of gram-positive bacteria and a member of the micrococcaceae family. Staphylococci are spherical bacteria that are found primarily on the skin and in the mucous membranes of humans and other warm-blooded animals, and aggregate into small, grape-like clumps. Staphylococci can be divided into two groups, i.e. coagulase-positive and coagulase-negative staphylococci. Overall, there are about thirty species of staphylococci.
Staphylococci can cause a wide variety of diseases in humans either through toxin production or invasion. Staphylococcus aureus (S. aureus) has been recognized as one of the most important and lethal human bacterial pathogens since the beginning of the previous century. Until the antibiotic era, more than 80% of the patients growing S. aureus from their blood died. Through infections caused by coagulase-positive S. aureus were generally known to be potentially lethal, coagulase-negative staphylococci has been dismissed as avirulent skin commensals incapable of causing human disease. However, over the past 30 years, coagulase-negative staphylococcal infections have emerged as one of the major complications of medical progress. They are currently the pathogens most commonly isolated from infections of indwelling foreign devices and are the leading cause of nosocomial (hospital-acquired) bacteremias in US hospitals. Staphylococcal infections are commonly treated with antimicrobial agents. However, the ascendancy of staphylococci as pre-eminent nocosomial pathogens also has been associated with a major increase in the proportion of these isolates that are resistant to (multiple) antimicrobial agents. Of the estimated 2 million hospital infections in the US in 2004, 70% was resistant to at least one antibiotic, thereby causing major medical and consequently economic problems. Ninety percent of the staphylococci strains are penicillin resistant, leaving only methicillin and vancomycin to treat the majority of infections. However, with increasing numbers of reports of methicillin-resistant Staphylococcus aureus (MRSA) chemists are faced with the daunting task of generating new antibiotics with novel modes of action. Despite the urgent need for the development of new antibiotics, the major pharmaceutical companies appear to have lost interest in the antibiotic market. In 2002, only 5 out of the more than 500 drugs in phase II or phase III clinical development were new antibiotics. In the last 6 years only 10 antibiotics have been registered and only 2 of those did not exhibit cross-reactivity with existing drugs (and thus not subject to the same patterns of drug resistance). This trend has been attributed to several factors: the cost of new drug development and the relatively small return on investment that infectious disease treatments yield compared to drugs against hypertension, arthritis and lifestyle drugs e.g. for impotence. Another contributing factor is the increasing difficulty in finding new targets, further driving up development costs. Therefore, investigation into novel therapies or preventative measures for (multi-drug-resistant) bacterial infections is urgently needed to meet this impending healthcare crisis.
Active immunization with vaccines and passive immunization with immunoglobulins are promising alternatives to classical small molecule therapy. A few bacterial diseases that once caused widespread illness, disability, and death can now be prevented through the use of vaccines. The vaccines are based on weakened (attenuated) or dead bacteria, components of the bacterial surface or on inactivated toxins. The immune response raised by a vaccine is mainly directed to immunogenic structures, a limited number of proteins or sugar structures on the bacteria that are actively processed by the immune system. Since these immunogenic structures are very specific to the organism, the vaccine needs to comprise the immunogenic components of all variants of the bacteria against which the vaccine should be protective. As a consequence thereof, vaccines are very complex, take long and are expensive to develop. Further complicating the design of vaccines is the phenomenon of ‘antigen replacement’. This occurs when new strains become prevalent that are serologically and thus antigenically distinct from those strains covered by the vaccines. The immune status of the populations at risk for nosocomial infections further complicates vaccine design. These patients are inherently unwell and may even be immunocompromised (due to the effect of immunosuppressive drugs) resulting in delayed or insufficient immunity against the infecting pathogens. Furthermore, except in the case of certain elective procedures, it may not be possible to identify and vaccinate the at risk patients in time to give them sufficient immune protection from infection.
Direct administration of therapeutic immunoglobulins, also referred to as passive immunization, does not require an immune response from the patient and therefore gives immediate protection. In addition, passive immunization can be directed to bacterial structures that are not immunogenic and that are less specific to the organism. Passive immunization against pathogenic organisms has been based on immunoglobulins derived from sera of human or non-human donors. However, blood-derived products have potential health risks inherently associated with these products. In addition, the immunoglobulins can display batch-to-batch variation and may be of limited availability in case of sudden mass exposures. Recombinantly produced antibodies do not have these disadvantages and thus offer an opportunity to replace immunoglobulins derived from sera.
Murine monoclonal antibodies directed against staphylococci are known in the art (see WO 03/059259 and WO 03/059260). However, murine antibodies are limited for their use in vivo due to problems associated with administration of murine antibodies to humans, such as short serum half life, an inability to trigger certain human effector functions and elicitation of an unwanted dramatic immune response against the murine antibody in a human (HAMA).
In WO 03/059259 and WO 03/059260 the attempts have been made to overcome the problems associated with the use of fully murine antibodies in humans by preparing chimeric antibodies. A disadvantage of these chimeric antibodies is however that they still retain some murine sequences and therefore still elicit an unwanted immune reaction, especially when administered for prolonged periods.
WO 2004/043405 relates to polysaccharide vaccines for staphylococcal infections, prepared from poly N-acetylglucosamine (PNAG) surface polysaccharide from Staphylococci, and the deacetylated form thereof (dPNAG). WO 2004/043405 also discloses rabbit antiserum to PNAG and dPNAG, coupled to Diphteria Toxoid (DTm).
Although WO 03/059259, WO 03/059260 and WO 2004/043405 refer to human antibodies as desired molecules, the antibodies actually disclosed and used therein are partly of murine or completely of rabbit origin, and none of these documents actually discloses any human antibodies, nor sequences thereof.
In view of their therapeutic benefit in humans, there is thus still a need for human monoclonal antibodies against Staphylococci. The present invention provides these antibodies and their sequences, and shows that they can be used in medicine, in particular for diagnosis, prevention and/or treatment of staphylococcal infections.